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Self-Inserted Needles in the Heart
Marco Di Paolo1, Benedetta Guidi2, Giuseppe Vergaro3
1Section of Legal Medicine, University of Pisa, S. Chiara Hospital, Pisa, Italy.
Insights
A rare case of self-inflicted cardiac injury presented as acute coronary syndrome. Autopsy revealed multiple metallic foreign bodies, highlighting the importance of considering unusual diagnoses in chest pain cases.
Area of Science:
- Cardiology
- Forensic Pathology
- Medical Imaging
Background:
- Penetrating cardiac injuries typically present with clear clinical signs.
- Misleading presentations can complicate the diagnosis of cardiac trauma.
Observation:
- A 38-year-old male presented with chest pain, elevated myocardial necrosis biomarkers, and ECG/echocardiogram changes suggestive of acute coronary syndrome.
- Despite initial workup for acute coronary syndrome, the patient experienced clinical deterioration and death.
Findings:
- Delayed chest radiography and subsequent autopsy revealed multiple metallic foreign bodies within the thorax.
- The patient had self-inserted cardiac lesions with a highly atypical clinical presentation.
Implications:
- This case underscores the necessity of considering non-ischemic etiologies, including self-inflicted foreign body injuries, in patients with chest pain and cardiac abnormalities.
- Diagnostic strategies for chest pain should remain broad, especially when clinical presentations are incongruent with initial findings.
- Autopsy remains crucial for identifying unexpected causes of death and clarifying complex medical cases.
Abstract:
Cardiac injuries due to penetration by sharp foreign bodies usually have a clear clinical presentation. A case of a 38-year-old man with self-inserted cardiac lesions and a misleading presentation is reported. The patient was admitted to the emergency room because of chest pain, with increase in biomarkers of myocardial necrosis, and electrocardiographic and echocardiographic abnormalities inducing initial diagnostic and therapeutic workup of acute coronary syndrome. Once clinical destabilization followed by death had occurred, the suspicion of an alternative diagnosis came from delayed chest radiography, confirmed by autopsy, revealing the presence of multiple metallic objects within the thorax.